Perioperative music listening as a non-pharmacological adjunct in enhanced recovery after total knee arthroplasty under neuraxial anaesthesia: A systematic review and meta-analysis
Kramer Chall, Siddharth Komperla, Ali Abdelaal, Ravish SeeruthunIntroduction:
Patients undergoing total knee arthroplasty under neuraxial anaesthesia remain awake within a stressful operative environment. Music listening is a low-cost, non-pharmacological intervention that may reduce anxiety and pain.
Methods:
We searched PubMed, MEDLINE, Embase and Cochrane Central Register of Controlled Trials from inception to April 2026. Standardised mean differences were pooled using random-effects models; risk of bias was assessed with Cochrane Risk of Bias 2.
Results:
Eight randomised controlled trials (440 participants) were included. Music listening significantly reduced postoperative anxiety (standardised mean difference = −0.95; 95% confidence intervals: −1.34 to −0.55) and postoperative pain at 24 h (standardised mean difference = −0.81; 95% confidence interval: −1.23 to −0.39) and was associated with reduced opioid consumption, lower intraoperative sedation requirements, fewer conversions from neuraxial to general anaesthesia and higher patient satisfaction. Subgroup analysis suggests that a proportion of the benefit may be attributable to noise isolation from headphones alone rather than to music.
Conclusion:
Low-certainty evidence suggests music may be an optional, low-cost adjunct within enhanced recovery after surgery pathways for total knee arthroplasty. Further research is needed to refine optimal intervention protocols and validate benefits in larger multicentre trials.